The Gyneco-Obstetric Stubbornness...and the perpetuation of one of the greatest mistakes of Womens Medicine Nelson Soucasaux - Gynecologist and writer As I observed in my book Novas Perspectivas em Ginecologia (New Perspectives in Gynecology), contrary to many peoples suppositions, the intrusion of obstetricians and surgeons into Gynecology has always been one of the more problematic aspects of Womens Medicine along time. Obviously the obstetricians main interest is directed to pregnant women. They look at women from the point of view of Obstetrics. Nevertheless we must remark that, as Womens Medicine, Obstetrics is a specialty which by far transcends women, since it is also devoted to embryos and fetuses. ( As to this subject, presently we must consider the enormous development of Fetal Medicine, a new branch of Obstetrics. ) We must also remark that Obstetrics only takes care of women in very peculiar periods of their lives, periods in which women house inside their bodies beings other than women themselves and who equally are subject of the specialty. Here we already have one of the enormous differences between Gynecology and Obstetrics, since Gynecology is exclusively devoted to women. Considering that the great majority of modern women only want to become pregnant and have children, as they actually do, in very few moments of their lives, it is easy to realize that Obstetrics is a specialty that only takes care of women in moments of exception. On the other hand and contrary to Obstetrics, Gynecology takes care of women during most of their lives. In this way, as a consequence not only of the need for having more patients but also of the frequent longing for omnipotence existing in Womens Medicine, obstetricians never fail to also practice Gynecology... In fact, this is a highly smart professional strategy for gaining and preserving the greatest number of patients as possible. Nevertheless, given the increasing complexity of modern Medicine, this strategy inevitably implies a great loss in the quality of the medical assistance that is provided, since presently it is humanly impossible for the same physician to practice two different medical specialties with the necessary competence and expertise. In Novas Perspectivas em Ginecologia I made it quite clear that the enormous differences between Gynecology and Obstetrics concern mostly their respective clinical, physiological, pathological and therapeutic aspects, that are completely different - besides the obvious fact that, while Gynecology takes care only of women, Obstetrics takes care of women and fetuses. For all these reasons Gynecology and Obstetrics constitute, without any possibility of rational doubt, separate medical specialties. In my opinion, all the constantly repeated opposing arguments are totally devoid of scientific basis and what they actually intend is, above all, to protect the tradition and some professional and corporate interests that cannot be publicly confessed. Considering the enormous technical progress of present-day Medicine, from the point of view of medical knowledge and training it is humanly impossible for the same physician to simultaneously and satisfactorily practice two medical specialties so complex and different as Gynecology and Obstetrics. Even so, the irrational insistence on the integrated practice of both specialties by the same professional persists... To my point of view, this attitude is typically illusory and even megalomaniac. And, to make things worse, at least here in Brazil that attitude is being more and more stimulated and even established by societies of Gynecology and Obstetrics that, with growing stubbornness and great political power, advocate the continuation of the scientifically irrational fusion of both specialties. As most women regrettably are not aware of the problems resulting from this traditional fusion between Gynecology and Obstetrics, they naively consider the integrated practice of both specialties as ideal and normal. This mistake is understandable on the part of the patients, but unforgivable on the part of the medical class. By the way, sometimes we can even verify the existence of some confusion between Gynecology and Obstetrics on the part of people who are not from the medical area. This just happens because most of the physicians who practice Womens Medicine introduce themselves as gynecologists and obstetricians... Therefore the colleagues are those who colaborate the most for the maintenance of such confusion, since they have the greatest interest on satisfying the naive and mistaken aspirations of most patients. It is obvious that, professionally, the gyneco-obstetricians take the maximal advantage of such position, while patients are frequently harmed without being aware of that ... As a result of all of this and regarding professional competition, there is also a subtle process of exclusion of the gynecologists who do not practice Obstetrics. Note 1: Because of the present-day accumulation of technical medical knowledge, the possibility of each physician acquiring a complete mastery of his own specialty becomes more and more restricted. This happens because the medical specialties themselves are going through a continuous process of division into subespecialties. In this way, the traditional bad habit of the practice of Gynecology, Gynecologic Surgery and Obstetrics by the same physician becomes more and more impracticable and absurd because it actually implies the practice of three different specialties by the same professional. Considering the human limitations - not only cognitive, but also of training and continuous updating -, will it be possible for the same physician to practice these three areas with the necessary competence ? Note 2: For more details on this subject, see my aforementioned book Novas Perspectivas em Ginecologia ( New Perspectives in Gynecology ), released in 1990, nelsonginecologia.med.br/novas.htm
Posted on: Mon, 11 Aug 2014 04:59:13 +0000
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